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Physical violence against women comes in many forms. In recent years, women’s rights researchers and advocates have raised awareness of one lesser-known expression of gender-based abuse: obstetric violence. They agree that disrespectful care in childbirth such as threats, bullying, and unconsented procedures infringe on women’s rights and potentially lead to serious health consequences. In 2014, two social media campaigns, #breakthesilence and #somostodasadelir (“We are all Adelir”), protested the forced cesarean sections performed on Rinat Dray in Staten Island and Adelir Carmen Lemos de Goés in the southern Brazilian state of Rio Grande do Sul. It appears that concerns around maternity health and safety are increasingly resonating with women globally.

UK-based childbirth Educator Jesusa Ricoy has stood at the forefront of such initiatives that push for safer labor and childbirth experiences.

Jesusa, you call yourself a “matriactivist.” Can you define this term for us and explain how it affects your stance regarding childbirth and women’s rights?

I came up with this term because every time I had to tell anyone what my activism was about, it was a lengthy explanation. And probably at the same time I came to realize that the activism around birth had to go beyond just birth; it had to challenge our entire understanding of our physiology - menstruation, sexuality, menopause, and breastfeeding. “Matriactivism” is a matriarchal activism and part of feminism.

You founded the International Roses Revolution campaign in 2011. What sparked this organization? Please tell me about some of your initiatives, strategies, and goals.

The movement was triggered by the outrage that quite a lot of Spanish women felt when the Spanish association “El Parto Es Nuestro” (“Birth is Ours”) discovered that on the website of the Spanish Society of Gynecologists and Obstetricians they had various comic strips where they laughed at women, their bodies, their prolapsed uteruses, and birth experiences. The doctors themselves were upset that these women didn't tolerate their sense of humor. It was such an insult to women, and women came to my Facebook page feeling so frustrated. I felt we had to do something, so I said: take a rose and write what they did to you and leave the rose in the hospital, on a square, outside the Ministry of Health building... So I organized various gatherings through Facebook, and now the rose and the movement belong to women. I feel very happy to hear that many women found strength in doing something physical and tangible with their trauma.

This is such an empowering initiative! What happened to Rinat Dray and Adelir Carmen Lemos de Goés?

Both women had cesareans against their will. In the case of Adelir, she was taken by police force to a hospital while she was in early labor at home, with a judge order. This is something that possibly happened also in Spain with an induction last month, it is still unclear. There is also the horrific forced episiotomy of Kimberly which one can see on YouTube (currently on trial thanks to the organization “Improving Birth”). She was cut twelve times in her vulva, while saying no. What happened is that all these women were dealt with as if they were dangerous, irrational, and irresponsible, simply because they expressed their informed decisions and contradicted the doctors. They were punished by trigger-happy doctors blinded by power and misogyny.

I read that you organized protest rallies following Adelir’s forced c-section.

Yes, I did. I asked my brother who is an illustrator to create the logo for the campaign, which was very powerful - the Brazilian flag cut transversally and bleeding like in a cesarean procedure. And we went to the embassies with leaflets. There were lots of movements from different organizations around the world, and we all stood beside Adelir. The good news is that because of all the "noise" of these campaigns, the situation with the cesarean rate was brought to the public debate and it became clear that it was a national embarrassment. However, I wish Adelir would have never had to go through that in order to generate the much needed attention.

What do the medical systems in the United States and Brazil, and even Spain, have in common that such incidents can occur? Could this really happen anywhere or are these cases isolated?

Countries such as Brazil and the United States share various conditions that make these situations a possibility. Private health care is one as we see in many countries because when money plays a part, cesareans and unnecessary interventions tend to double in the statistics. But also those countries are a bit like mine, Spain, and others in Europe in that they have little respect for midwives, and midwifery has sadly been absorbed and transformed by the current obstetric care which is obsolete, male dominated, and heavily medicalized. In this culture, birth is a pathology that requires high levels of expertise and the latest technology. Mix that with a continuous promotion in movies and the media of women being reduced to their looks and bodies, and labor being the worst thing that happens in life, and there you have it: 85% cesareans in Brazil, and women in the U.S. on a pitocin drip as soon as they walk through the door.

As I say, in Europe we have similar problems with our own peculiarities. I think the UK, where I live, is a bit of an exception because of the strong presence of women and The Royal College of Midwives and the many years of childbirth activism. But Spain, Italy, Ireland, and Greece, just to name a few, are countries with their own problems in obstetric violence and a clear culture of the over-medicalization of birth due to machismo attitudes, religion, and the fact that 86% of the media we consume comes from the U.S., which unfortunately validates and perpetuates that way of birthing and the disempowerment of women.

So, these cases are not exceptional, I'm afraid, and that's why, after listening to so many, we are all trying to compile the data by creating O.V.O.’s (“Observatorio de la Violencia Obstétrica”) that are like watchdogs for obstetric violence. The first one, which is the one that I belong to, was created in Spain, but now we have an Inter-O.V.O. that is a network of all the South American countries’ watchdogs and Italy's and Germany's too, if my memory doesn't fail me.

That is all very true and so unsettling. In my home country, Germany, midwives are being pushed out of the hospitals because they can no longer afford horrendously high insurance costs. Is this an unstoppable trend or do you think we can turn things around for the sake of women’s health and empowerment?

I think, unfortunately, it is a trend benefiting from a widespread lack of understanding in society about physiological birth and the common acceptance of women as submissive recipients of care. However, there are a lot of movements and opportunities, and many amazing professionals, even Jamie Oliver, the chef, has contributed recently by saying that his kids have witnessed his wife laboring. Every gesture such as this interview counts.

Absolutely! My daughter, she was almost 5 years old, witnessed the birth of her brother. It seemed like it was the most natural, and not traumatizing event for her. She was very hands-on! I am curious to learn more about these watchdog organizations. How do they operate and what have they been able to accomplish?

Well, the first one came out of the Spanish organization “El Parto Es Nuestro.” We are 5 professionals (a lawyer, a psychiatrist, a gynecologist, a midwife, and me) and a team of various women from all walks of life who support us by compiling data and other various tasks. It is in its early days and it is all volunteer work from very busy women who are also mothers, but a lot of the work so far has been to create a strategy, to organize, network, and reply to the many emails we have received since establishing ourselves. We are working towards publishing some documents hopefully by the 25th November, which was established by The Roses Revolution as a day to fight obstetric violence as part of the International Day against Gender Violence.

I feel that obstetric violence is an international issue and an accepted form of gender violence, and in the case of the unnecessary cesareans, for example, we can clearly see the acceptance by our current culture of birth since nobody seems to be asking some pertinent questions such as: when did a medical procedure, a major surgery that should be used as an emergency procedure to save lives, become a common standard way of birth, an option, an ideal, an alternative and now, as we can see, an imposed method? Why is it that informed women exerting their will over their bodies and birth experiences are so scary to the current system of health and immediately labeled as irresponsible?

You are raising crucial points. The backlash a woman can experience when she tries to exert her rights to a non-invasive birth, obviously, is horrific. I personally had two home births and some friends, relatives, and colleagues challenged us a lot about our decision. And during my first pregnancy, the obstetrician, whom I abandoned at 32 weeks when I decided to have a home birth, became increasingly offensive as I educated myself about birth and my options. I am afraid that nobody would have felt alarmed if we had announced our wish to have highly-medicalized births.What needs to happen precisely to break down this structural sexism in the medical world?

We need the institutions of health to assume responsibility, we need women's health and care to be at the top of the agenda. We also need a new major wave of feminism. We need women to question and we need men to reject privilege. We need many things but very simply we need the just treatment we still don't have in 2016! We should be angry and taking to the streets!

You are doing tremendously important work and I want to thank you for that. Your activism has made quite a difference and this is exactly what we need. I admire your strength and perseverance, and I hope that together, us women can continue to impact the system to end physical violence in labor wards. Thank you so much for your time, Jesusa.

Thank you very much, Felicitas, for echoing and amplifying my words which are ultimately OUR words.